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A 56-year-old male, with history of situs inversus, presented dysphagia and vomiting, secondary to type II Achalasia.
The barium swallow showed a difficulty in its passage to the stomach, with incomplete relaxation of the lower esophageal sphincter (Image 1). The manometry reported the absence of primary peristalsis in the esophageal body. The gastroscopy showed a dilated and hypokinetic morphology in the esophagus, and closed cardias with resistance to passage.
Given the failure of endoscopic treatment, it was decided to perform laparoscopic Heller's esophagomyotomy with an anterior Dor hemifundoplication of 180º.
Post-operative course was uneventful, with immediate symptoms resolution and corrt oral tolerance.
